Procedure

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When a tooth's health is compromised by decay, a crack in the enamel or a small chip, a filling is required. When found by the Dentist during Routine Preventive Visits, these areas are often small and have gone undetected by the patient. When a patient is feeling discomfort from decay, a crack or a broken tooth, the affected area is often deeper and may require more extensive treatment.

Typically, local anesthesia is used. The compromised area of the tooth is gently removed using a handpiece and/or hand instruments. The prep is designed to remove the smallest amount of tooth structure necessary and to create a mechanical lock with the filling material. The filling is placed and contoured to match the existing tooth. Using colored bite paper, the filling is checked for proper occlusion (the bite between the upper and lower teeth). Once complete, the filling is burnished or polished to ensure smoothness to the patient's tongue and cheek.

Today, dentistry is capable of providing the patient with alternatives in dental filling materials that provide good function as well as natural looking results.

Amalgam Fillings

Amalgams are the conventional filling material which have been historically used in posterior (back) restorations due to their strength and longevity. It is a metal based filling material which appears silver or steel in color. After being compressed into the prepared tooth, the Dentist has a limited amount of time to shape and contour the amalgam with hand instruments before the material hardens. Once complete, the edges are burnished smooth to help prevent future micro-leakage.

Composite Resins

Composite Resins are tooth colored fillings which belong to the glass ionomer or plastic family of dental materials. Composite restorations are commonly done on anterior (front) teeth for their esthetics, but more recently, they have become popular in the posterior (back) to create a more natural look. Composite Resins are ideal for small corrections in which most of the tooth is healthy and stable. They are a more esthetically pleasing alternative to amalgam fillings and have similar characteristics to tooth enamel. Patients should be aware, however, that the use of this material in the posterior may incur a higher co-payment due to the rules and regulations outlined by their insurance company.

After prepping the tooth for a Composite Resin, the Dentist will apply a mild etching solution to the enamel surrounding the area. This solution roughens the surface microscopically which allows for a stronger bond between the tooth and resin. Next, a bonding agent is placed and activated with ultra-violet light. The Composite Resin is compressed into the tooth and is also treated with UV light. This hardens the material. The dentist then sculpts the Resin with polishing burrs to the desired shape and bite.

Pulp Cap Medications

How deep a tooth is prepared for a filling solely depends on how deep the tooth is compromised by decay, a crack or break. Depending on the depth, the Dentist may choose to place a layer of medication on the floor of the prep before compressing the filling material. If the Dentist feels the prep is deep but has maintained a healthy layer of dentin between the bottom of the prep and the pulp (nerve) tissue, an indirect pulp cap will be placed. This medicated liner acts as a buffer between the filling material and the living tooth. It helps to lessen temperature sensitivity with deep fillings and soothes the internal tooth structure. If, however, the dentist feels they are directly above the pulp or a pin-hole exposure of the nerve occurs, a direct pulp cap would be placed. This thicker medication protects the pulp from coming in contact with the filling material, and acts as a buffer between the filling and the pulp tissue. Patients should know, however, that although Direct Pulp Caps are successful in extending the life of a tooth, it is likely the tooth will need root canal therapy in the future.

Soft Tissue Gingivectomy

When a cavity develops below the gum line, it becomes necessary to remove gingival tissue to expose the area affected by decay. This is necessary to ensure that all decay is removed and a proper job is done. While under local anesthesia for the dental restoration, a small amount of gingival tissue is removed to expose the decay site. Done with an Electric Scalpel, the tissue is removed and cauterized at the same time, reducing the amount of bleeding around the prep. This assures proper bonding and eliminates future leakage around the edge of the new filling. After the filling is complete, the patient is normally placed on a prescription mouth rinse for the surgical area. The gingiva heals within 2-3 weeks of the procedure.

A cavity is below the gum line preventing it from being filled easily.

The Dentist gently opens the area.

He then contours the bone to lower the gum line.

The bone has been lowered which will lower the level of the gum when it heals.

The area has been closed up and now the cavity is exposed and can be filled.